Do Vaccine Mandates on Childcare Services Work?

Here is the latest paper I have published with Ang Li that provides an evaluation of No Jab No Play policies that have been enacted in a series of Australian states.  Here is the title and abstract: 

 Title:  

Vaccine mandates on childcare entry without conscientious objection exemptions: A quasi-experimental panel study

 Abstract: 

Objectives

Examine the effect of No Jab No Play policies, which linked vaccine status to childcare service entry without allowing for personal belief exemptions, on immunisation coverage.

Study design

Immunisation coverage rates from the Australian Immunisation Register were linked to regional level covariates from the Australian Bureau of Statistics between January 2016 and December 2019. Differential timings of policy rollouts across states were used to assess changes in coverage with the implementation of policies with generalised linear models. Quantile regression and subgroup analysis were also conducted to explore the variation in policy responses.

Results

Baseline mean vaccination rates in 2016 were 93.4% for one-year-olds, 91.2% for two-year-olds and 93.2% for five-year-olds. Increases in coverage post-policy were significant but small, at around 1% across age groups, with larger increases in two and five-year-olds. Accounting for aggregate time trends and regional characteristics, implementation of the policies was associated with improved full immunisation coverage rates for age one (post-year 1: 0.15% [95 %CI–0.23; 0.52]; post-year 2: 0.56% [95 %CI 0.05; 1.07]), age two (post-year 1: 0.49 [95 %CI: 0.00; 0.97]; post-year 2: 1.15% [95 %CI: 0.53; 1.77], and age five (post-year 1: 0.38% [95 %CI 0.08; 0.67]; post-year 2: 0.71% [95 %CI 0.25; 1.16]. The policy effect was dispersed and insignificant at the lowest quantiles of the distribution of immunisation coverage, and smaller and insignificant in the highest socioeconomic areas.

Conclusion

Findings suggest that No Jab No Play policies had a small positive impact on immunisation coverage. This policy effect varied according to prior distribution of coverage and socio-economic status. Childcare access equity and unresponsiveness in high socioeconomic areas remain concerns.

 

'Removing conscientious objection: the impact of ‘no jab no pay’ and ‘no jab no play’ vaccine policies in australia': New Paper

I have a new paper with Ang Li (reseachgate here) just published in Preventive Medicine on the impact of No Jab, No Pay  and No Jab, No Play on vaccine coverage rates.

We found that these policies, which removed non-medical exemptions from government benefits and childcare enrolments, were occasioned by an increase in vaccination coverage across states between 2-4% for one-year olds, 1-1.5% for two-year olds, and 1-3.5% for five-year-olds.

We also found that the effect of the policy differed significantly depending on characteristics of the area.

Areas that were characterised by either: lower socio-economic status, lower median income, more Family Tax Benefit recipients, or higher pre-intervention coverage had greater responsiveness to the policy changes.

Variation in response to the policy changes across areas suggest the effect was largely led by lower-socioeconomic status parents who were nudged towards full vaccination, while more affluent parents were relatively unaffected.

Title: Removing conscientious objection: The impact of ‘No Jab NoPay’and ‘No Jab No Play’vaccine policies in Australia

Hightlights: 

• Removing conscientious objection increased overall childhood vaccination coverage.
• The policy responses were heterogeneous.
• Socioeconomically advantaged areas were less responsive to policy changes.
• Benefit-dependent and lower-income areas were more responsive to policy changes.
• Areas with pre-existing low coverage were more persistent and less responsive.

Abstract: Vaccine refusal and hesitancy pose a significant public health threat to communities. Public health authorities have been developing a range of strategies to improve childhood vaccination coverage. This study examines the effect of removing conscientious objection on immunisation coverage for one, two and five year olds in Australia. Conscientious objection was removed from immunisation requirement exemptions for receipt of family assistance payments (national No Jab No Pay) and enrolment in childcare (state No Jab No Play). The impact of these national and state-level policies is evaluated using quarterly coverage data from the Australian Immunisation Register linked with regional data from the Australian Bureau of Statistics at the statistical area level between 2014 and 2018. Results suggest that there have been overall improvements in coverage associated with No Jab No Pay, and states that implemented additional No Jab No Play and tightened documentation requirement policies tended to show more significant increases. However, policy responses were heterogeneous. The improvement in coverage was largest in areas with greater socioeconomic disadvantage, lower median income, more benefit dependency, and higher pre-policy baseline coverage. Overall, while immunisation coverage has increased post removal of conscientious objection, the policies have disproportionally affected lower income families whereas socioeconomically advantaged areas with lower baseline coverage were less responsive. More effective strategies require investigation of differential policy effects on vaccine hesitancy, refusal and access barriers, and diagnosis of causes for unresponsiveness and under-vaccination in areas with persistently low coverage, to better address areas with persistent non-compliance with accordant interventions.

 

Here is link for access: https://doi.org/10.1016/j.ypmed.2020.106406.  

Vaccine Sentiments and Under-vaccination: New Paper

.@ANGLIhere and my paper "Vaccine sentiments and under-vaccination" is now out about in the world and online for everyone to see: https://t.co/bEn4HBE75w

— Mathew Toll (@MGHToll) November 18, 2020

New paper out co-authored with Ang Li on the issue of vaccine hesitancy and under-vaccination that looks at the factors associated with vaccine attitudes (very strongly agree with vaccines to very strongly disagree with vaccines) and vaccine behaviours around the MMR vaccine (full dosage, partial dosage, no dosage).  And the consistency between factors associated with attitudes and behaviours, showing when practical barriers impede the translation of positive vaccine attitudes into full uptake. 

Title: “Vaccinesentiments and under-vaccination: Attitudes and behaviour around Measles,Mumps, and Rubella vaccine (MMR) in an Australian cohort”

Abstract: 

Objective

The study aimed to examine the consistency in factors associated with attitudes towards vaccination and MMR vaccination status.

Methods

Using the nationally representative Longitudinal Study of Australian Children matched with the Australian Childhood Immunisation Register, 4,779 children were included from 2004-2005 to 2010–11. Different MMR vaccine dosages and general attitude towards vaccination were modelled individually with multinomial logit regressions, controlling for demographic, socioeconomic, and health related factors of the children and their primary carers.

Results

The group with non-vaccination and negative attitudes was characterised by more siblings and older parents; the group with under-vaccination but positive attitudes was characterised by younger parental age; and the group with under-vaccination and neutral attitudes was characterised by less socioeconomically advantaged areas. The presence of parental medical condition(s), being private or public renters, and higher parental education were associated with under-vaccination but not with attitudes towards vaccination, whilst parental religion was associated with attitudes towards vaccination but not reflected in the vaccine uptake.

Conclusions

Vaccine attitudes were largely consistent with MRR vaccine outcomes. However, there was variation in the associations of factors with vaccine attitudes and uptake. The results have implications for different policy designs that target subgroups with consistent or inconsistent vaccination attitudes and behaviour. Parents with intentional and unintentional under-vaccination are of policy concern and require different policy solutions.

------

Here is a share link that allows free access for the first 50 days: https://t.co/XJlSK3Jcix?amp=1